Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A50182 | CA |
Y | 208D00000X | General Practice Physician | A50182 | CA |
NPI | 1245525690 |
---|---|
Provider Name | Mahendra G Sanathra |
First Address | Los Angeles, CA 90001-2754 |
Second Address | Los Angeles, CA 90001-2754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 14/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A501821 | (05) | CA |
A50182 | STATE LICENSE (01) | CA |
F19155 | (02) | CA |